SURGICAL METHODS AMONG SAVAGE RACES. 

By EDWIN LEE MORGAN, M. D., 

Washington, D. C. 



REPRINTED FROM 

WASHINGTON MEDICAL ANNALS, 
Vol. in, No. I, 1904. 



SURGICAIv METHODS AMONG SAVAGE RACES. 

By EDWIN LEE MORGAN, M. D., 
Washington, D. C. 



REPRINTED FROM 

WASHINGTON MEDICAL ANNALS, 
Vol. Ill, No. I, 1904. 



GlYf 77 
.5 

54 WASHINGTON MEDICAL ANNALS ' ^^ ^ 

SURGICAL METHODS AMONG SAVAGE RACES.* 

By EDWIN LEE MORGAN, M. D., 

Washington, D. C. 

This paper, which I present for j^our consideration, does not 
exhaust the subject — the history of surgery among savages. I 
have collected a few of the more important operations and cus- 
toms as practised by primitive people. 

In the earlier ages, the doctor and surgeon were one and the 
same person, but as time rolled on, the physician and surgeon be- 
came distinct personages. The old custom of the chirurgeon and 
physician being one and the same party is found in the country 
medical man of our centur5^ Time, in this latter respect, has 
made no change. 

I claim nothing original in m}^ paper. I present the labors of 
others ; their scientific gems of research and thought. 

Sydenham, according to Berdoe, called Hippocrates "the Romu- 
lus of Medicine, whose heaven was the empyrean of his art. He 
it is whom we can never duly praise." He termed him "that 
divine old man," and declares that he laid the immovable foun- 
dations of the whole superstructure of medicine when he taught 
that '^ our natures are the physicians of our diseases.''^ 

Scabies was the goddess of itch. The plague-stricken prayed 
to the goddess Angeronia. Women, in their troubles, sought the 
aid of Fluonia and Uterina. Ossipago was the goddess of the 
navel and bones of children. There were many goddesses of mid- 
wifery. " Carna presided over the abdominal viscera;" bacon 
and beans were offered as a sacrifice to her. St. Augustine ' ' pours 
his satire and contempt on women's goddess." 

Pliny complained ' ' that people believed in any one who gave 
himself out for a doctor, even if the falsehood directl}^ entailed 
the greatest danger. 

' ' Unfortunately there is no law which punishes doctors for 
ignorance, and no one takes revenge on a doctor if through his 
fault some one dies. It is permitted him by our danger to .learn 
for the future, at our death make experiments, and without hav- 
ing to fear punishment, to set at naught the life of a human 
being." 

This was Pliny's statement in remote ages, and yet we know 

* Read before the Medical Society of the District of Columbia, Februarj- lo, 1904. 



WASHINGTON MEDICAI. ANNALS 55 

today the unfortunate doctors were too often killed among prim- 
itive people. I knew of a case where the medicine man out West 
among the Indians was killed when the patient died. 

Among some savages, " as in Ponape, boys are always subject 
to semi-castration, as Dr. Finsch remarks, in order to prevent the 
possibility of orchitis, and further, because the girls consider men 
thus distinguished handsomer and more attractive." L^ike re- 
moving a healthy appendix to prevent any future trouble. The 
incision of the perineum before labor was used by primitive peo- 
ple, and its mechanical closure afterwards. 

The Africans seem to enjoy a " freedom from puerperal fever, 
and the impunity with which abortions are produced," with no 
bad after effects. These natives recover from wounds and opera- 
tions without sepsis, and without manifesting pain. Clot Bey 
states that native Egyptians are good subjects for operations, 
' ' shock being unknown and the dread of operation not existing. ' ' 
The Jesuit- Father Cronenberg. says Dr. Gihon, " attributes the 
marvelous rapidity of healing of wounds among the Zulus and 
other savage tribes not 'alone to climate and mode of living, but 
to the natural endowment of the people." " Felkin finds the tac- 
tile sensibility of Europeans, Arabs and Negroes to be in the 
proportion i, 2, 3, the last exhibiting in consequence their stoical 
indifference to pain." Dr. Grant (Be}'-) "calls attention to the 
destruction of life and, consequently, influence on the number of 
births in Egypt from craniotomy performed b}^ ignorant mid- 
wives ; and the thousands of criminal abortions practiced by them 
are also a factor in reducing the normal birth rate." 

Dr. Gihon, quoting from an authorit}' on China, says: "The 
Chinese claim to be in possession of a treatment for hydrophobia 
not like Pasteur's, which reduced the mortality to one per cent." 

Dr. George Kober's translation of Dr. Max Bartel's work states: 
"Whilst many deny that our North American Indians possess 
any therapeutic knowledge, it is nevertheless true that in suppur- 
ative and sloiig/iiiig zacmuds the Shaman prepares a decoction of 
willows, and by blowing it either directly from his mouth, or by 
use of a reed, he thoroughly cleans the wound, and thus emplo5'S, 
whether knowingly or not, I do not pretend to say, an antiseptic 
solution, the active principle of which we all know is salicj'lic 
acid ; moreover, the Dakotas, in suppurating wounds, not infre- 
quentl}^ introduce drains made of the bark of trees, and also em- 



56 WASHINGTON MEDICAL ANNALS 

ploy a primitive syringe made from an animal bladder and a 
quill." 

Mv own observation leads me to believe our Indians do tise remedies 
and employ surgical treatme7it among their sick and ijijured, in many 
cases intelligently , and not as a result of rnagic or Shamanism, 
although the latter greatly prevails in their management of patients. 

' 'Attempts to close wounds with sutitres are not infrequent. School- 
craft refers to some of our Indian tribes who employ sutures made 
of sinew or tree bark which are permitted to remain until after 
the sixth day. The natives of South Australia resort to com- 
pression, and the Winnebagos never permit ugly wounds to heal 
by first intention, but keep them open, so as to heal from the 
bottom. ' ' 

It 7nust not be forgotten that savages^ like their civilized brothers, 
acquire knowledge by contact with an enlightened race. The mis- 
sionaries, explorers, traders and the army may be responsible for 
some seemingly advanced medical and surgical treatment in sick- 
ness and injuries in our country among the Indians. 

"According to Wolif, the negroes of Ottango treated a gunshot 
wound of tibia quite skillfully by means of a grass splint, made 
of swamp grasses, extending above the knee and below the 
malleoli, securing the immobility of the fragments, leaving a 
fenestrated opening for the escape of discharges. Mincopies 
dress gunshot wounds with leaves. Samoans remove a spear 
head by a counter opening, and pull the missile through. To 
control hemorrhages, eagles' down, vegetable styptics, sometimes 
in conjunction with compression, the spongy part of an old cocoa- 
nut ; in Morocco, circular compression, and also hot pitch, if 
necessary ; primitive tourniquets are used in the South Sea 
Islands, in conjunction with a native fabric made of the paper 
mulberry tree. 

' ' The North American Indians, in violent nose bleeding, stuff 
the nostrils with hot pulverized charcoal." For epistaxis, some 
savages apply cold to the scrotum. The Mincopies treat skin 
diseases with a large heated flat stone. The Indians in Southern 
California treat primary ulcers of syphilis with a live coal. 

The Creeks and Winnebago Indians get fair results from their 
method of treating fractures, as compared with other savages. 
South Australians use a clay splint. They straighten the limb 
and apply the clay splint, which finally hardens. Bartel mentions 



WASHINGTON MEDICAIv ANNAIvS 57 

the case of a fractured femur where ' ' there was no perceptible 
lameness or shortening," and also a fractured jaw treated success- 
fully by a clay mask. 

My own observation has been, our Indians do not as a rule ob- 
tain good results in the treatment of fractures. I saw them use 
a slat splint in one case of fracture, and in a fractured humerus 
they wrapped something soft around the arm, and then applied 
two pieces of rawhide over this, encasing the arm and extending 
a few inches above and below the seat of fracture. They then 
tied the splint on. The splint used resembled two hemispheres, 
with flanges at each end. 

Schoolcraft states that the Indians do not know how to treat 
strangulated hernia, while in the reducible variety they use suit- 
able bandages. Many primitive people do not know how to treat 
hernia. Some use hot irons. In Morocco trusses are used. The 
natives of India operated on stone in the bladder but which re- 
sembles the European method of a hundred years ago. ' ' The 
finger is introduced into the rectum and the stone pressed against 
the perineum. An incision is made over the protruding part, and 
after dividing the walls of the bladder the stone is removed by 
means of forceps." Corre states the Fullahs of Rio Nunez extir- 
pate the cervical glands. 

I was told by the hidians, and also a Catholic priest, that an 
Okanagan sqziaw operated sziccessfidly for cataract in days gone by. 
This was about in 1879 or 1880 when I heard of this woman operat- 
ing on ej^es. I doubt the diagnosis for the following reasons : Ptery- 
gium was very common on the Columbia, Colville, Spokane, 
Okanagan, and other rivers of that locality from 1879 to 1886, 
when I left Chewelah. I have seen pter5^gium on both eyes, 
generally on the inner side toward the nose, and also on one eye ; 
then again, double on both eyes. This no doubt was the condi- 
tion operated upon by the Indian oculist. Bancroft refers to an 
operation on an Okanagan Indian, where the abdomen was laid 
open and a large quantity of fat was removed. The Indian op- 
erating closed the wound with stitches. 

A Chippewa Indian performed Caesarean section successfully on 
his wife. Felkin in Uganda, Central Africa (Dr. George Kober's 
translation of Dr. Max Bartel's work, etc.), describes Caesarean 
section he witnessed in that country.* 

*See also " Histoire des Accoucheinents Chez Tons Les Peuples," G. J. WitoUski, page 621. 



58 WASHINGTON MEDICAL ANNAI.S 

"The woman, a primipara, aged 20, was placed upon a reclin- 
ing couch, and after a partial stupefaction by means of banana 
wine, she was secured across her chest to the bed with a broad 
bandage made of bark fiber. Another bandage secured her thighs,, 
the ankles being held bj^ an assistant. A second assistant stood 
on the right side of the bed and fixed the abdomen, whilst the 
operator, with knife in his right hand, stood on the left side of 
the bed. After murmuring some incantation, he washed his own 
hands and the abdomen of the patient with some banana wine, 
and subsequently with water. 

' ' He uttered a shrill note, which was answered by the multi- 
tude without, and made his incision, reaching from the pubis to 
the umbilicus, dividing the abdomen and uterus with one stroke 
of the knife, so that the amniotic fluid gushed forth. All the 
bleeding points in the abdominal wall were promptly touched by 
an assistant with a red-hot iron. The operator quickly enlarges 
the uterine incision, whilst an assistant held the wound apart, and 
when the uterine opening was sufficiently enlarged, he extracted 
the child, which was given to another assistant, and the umbilical 
cord was promptly divided. 

' ' The operator now laid his knife aside, and rubbed and pressed 
the womb with both hands. He also introduced his right hand 
into the uterine cavity and dilated the cervix with two or three 
of his fingers, and then removed the placenta and blood clots 
through the abdominal wound. In the meantime the operator 
endeavored to secure firm contraction of the womb, while the as- 
sistant cautiously applied the actual cautery to all bleeding points, 
and another assistant was kept busy trying to prevent protrusion 
of the intestines. 

" The uterine wound was not sutured. The assistant relaxed 
his hold of the abdominal wound, which was covered with a por- 
ous grass mat, and the patient was lifted up and partly turned 
upon her side to permit of free drainage of the abdominal cavity, 
after which she was gently placed upon her back, the mat removed, 
and the abdominal wound closed by means of seven slender but 
well-polished nails, resembling acupressure needles, and a twisted 
suture made of vegetable fiber. The wound was covered with a 
thick paste, made from the chewed pulp of two different roots, 
over which a warm banana leaf was laid, and the whole secured 
by a firm bandage made of Mbugu fiber. 



WASHINGTON MEDICAI. ANNALS 59 

' ' The woman bore the above operation without complaint, and 
one hour afterwards rested very comfortably. Felkin reports 
that the temperature on the second evening was loi, and the 
pulse 1 08. The child was put to the breast two hours after the 
operation. On the third morning the dressings were removed, 
and a few of the needles ; the remainder were taken out on the 
fifth and sixth days. There was very little pus, which was re- 
moved by means of a spongy pulpa, and on the eleventh day the 
wound had entirely healed." Ovariotomy is practised amongst 
savage people. 

Operations on males to produce a viika man is an interesting 
procedure in Australia. Dr. J. G. Garson furnishes us with an 
account of this operation and custom. An artificial hypospadias 
is produced. 

"On Corpus Christi Creek, Western Australia, the natives 
content themselves with making a small incision through the 
urethra, immediately in front of the scrotum. Through this 
opening the semen is ejaculated during copulation after the wound 
is healed. 

" Second. — On the Diamantia and Ivower Georgiana the natives 
divide the urethra in front of the scrotum and again just below 
the glans penis, then cutting longitudinally along each side, dis- 
secting it out. 

" Third. — The most general plan of mutilation is that which I 
show you in a photograph. It is performed by placing a narrow 
piece of wood along the dorsum of the penis and drawing the loose 
skin tightly backward over the wood. A flint knife is then in- 
serted into the orifice, and the urethra is laid open to the scrotum. 
Before the operation is performed the penis is beaten till it is be- 
numbed. After the operation the penis is bandaged against the 
abdomen ; should excessive inflammation of the wound occur 
during the healing process, it is dressed with a kind of native 
clay or crushed eucalyptus leaves. The mortality after this op- 
eration is stated to be ni/. 

"A man seizes the prepuce between his thumb and forefinger 
and, stretching it to its fullest extent, while the headman of the 
tribe transfixes it with a flint knife of lancet shape, sharpened on 
both sides, cuts it off with one circular sweep. After cessation 
of hemorrhage it is dressed with soft down or eagle's hawk 
feathers." 



6o WASHINGTON MEDICAL, ANNAI^S 

The Mylagordi Method. — Divide the prepuce by four longitudi- 
nal incisions and dissect each segment backwards ' ' to the butt of 
the penis," removing each separately. "In the northern terri- 
tory the prepuce is scored with a flint knife and then dressed with 
irritating herbs so as to produce hypertrophy of the parts." Op- 
eration is done for cleanliness, etc. You can well imagine a pic- 
ture of those operated upon after healing, when the penis is in a 
state of erection. 

The method to make women barren in Australia to a certain 
extent is called Eurlltha. Dr. Garson states in his article in re- 
gard to these Australians that they operate on girls at the ages 
from ten to twelve years. They make a roll of emu feathers from 
seven to eight inches long, being thicker at one end than the 
other. It is tied tight around with twine made of opossum fur, 
and daubed with fat and red ochre. To the small end a cord of 
human hair "is attached, looped over it," being " brought down 
to the thicker end" of the roll. She is placed on her back ; the 
thin end of the roll, with loop, is introduced into the vagina. 
Then a flat piece of stick is passed into the vagina along the side 
of the roll, and the loop at the upper end is placed around the 
end of the cervix uteri and tightened slightly. After a consider- 
able period of time, and when the parts have become swollen, the 
operator, who is an old man or woman, twists the cord around 
his or her hand, and the portion of the cervix uteri within the 
loop is forcibly severed and drawn out with roll and loop. 

After three weeks a small flint knife attached to the end of a 
stick, six inches long, is passed into the vagina. A vertical and 
transverse incision is made into the stump of the cervix uteri. 
The incisions are packed " with duck or eagle's hawk's down " to 
keep them open. " I^umps of heated fat are now inserted to 
grease the parts and keep them clean." After the healing of 
these wounds, " the lower end of the posterior wall of the vagina 
is divided down to the anus," * * * " in order that sexual 
intercourse with the mika man maj^ be more eas5\" Dr. Garson 
states that only a few Australian tribes practise this operation in 
Central Australia. These women who have been operated upon 
are called "dindahs" or "dindees." 

I have thought it best to place the following bloody, puberty 
ceremonial under the head of cosmetic surgery, as scars are ad- 
mired by some savages. lyubbock states, "Among the females 



WASHINGTON MEDICAL ANNATES 6l 

on the Murray, the only ceremony of importance with which Erye 
was acquainted was that of scarring the back. Erye, indeed, 
calls it tattooing, but "crimping" would, I think, be a more 
correct expression. It takes place at the age of puberty, and is 
extremely painful. The woman kneels down and places her head 
between the knees of a strong old woman, and the operator, who 
is a man, cuts the back with a piece of shell or flint in rows of 
long, deep gashes from left to right quite across the back and com- 
pletely up to the shoulders. The whole scene is most revolting ; 
the blood gushes out in torrents and saturates the ground, while 
the cries of the poor victim gradually rise into screams of agony." 

This is a voluntary act on the part of the female, and shows 
what tortures women will endure to become envied by their owm 
sex ; beautiful and beloved as savages, and even as civilized 
women in our own era and country, in order to attract the oppo- 
site sex. 

Deforming the Heads of Living Children. — The Bari people com- 
press their children's heads in front of the ears, which " increases 
the height along the sagittal suture. ' ' The Monbuttu barbarians 
bandage the heads of their infants of the ruling family, "so as to 
lengthen the horizontal axis." Some of the natives of the island 
of Mallicolo ' ' have elongated deformation caused by the pressure 
in infancy of a pointed cap." Our American Indians have also a 
similar custom of flattening the heads of infants. I have heard 
Hudson Bay Fur Company men say many of these infants be- 
longed to the chieftain class. Deforming the skulls of the living 
was practised during Hippocrates' time, 460 B. C, and was also 
observed by StraboJand<^ Attila's Huns, even to the present 
time in Roumania.' Flattened skulls due to mechanical pressure 
are to be seen among the aborigines of South America and 
Oceanica. 

Suicide in Chi7ia. — Suicide is often of a surgical nature as well 
as medical, it being a form of murder, as is too often the case, 
when a man places himself in the hands of an inexperienced op- 
erator. Therefore I classify suicide under the head of surgery. 
Among the Chinese self destruction is common. The means em- 
ployed are opium or gold-foil eating, drowning, cutting the throat 
and cutting out the tongue, and thus they shuffle off this mortal 
coil. The cause, "a common form of melancholic insanity, is 
the Scythian disease of Hippocrates, due to the loss of virility 



62 WASHINGTON MEDICAL ANNALS 

and often complicated among the people of the Caucasus, Thibet 
and Japan with zoanthropia." The Japanese sends 3^ou a weapon 
to disembowel yourself with, and he does likewise. 

Cirauncision on Male and Female. — This is almost a universal 
operation, being performed by various tribes and races, is of the 
greatest antiquity, and males in the past have been operated upon 
for different reasons. Prof. McGee suggests as one what might 
be considered the theory of the evolution of clothing, showing the 
picture of a naked savage, having a string around his waist, at- 
tached to and extending along the penis and around the foreskin. 
In the course of time by heredity, etc., i. e., in future generations, 
the foreskin became enlarged, a nuisance, and was cut off. This 
theory is open to objections, one being whj^ do they todaj^ still 
use this mode of dressing ? And why not circumcise when a bab}^ 
thus avoiding holding the penis and prepuce with a cord ? 

The Egyptians of the era of Rameses II, 1370 B. C, practiced 
this rite, also the Jews and other races, both in the past and pres- 
ent. There is in Egypt an old ruin. The upper part of the sculp- 
ture is destroyed, but the lower part shows the operation under 
discussion as performed in ancient times. 

The Manyuena circumcise a slave first before operating on a 
chief's son. After a Dieri boy has been circumcised a rope of 
human hair taken from the men, women and children is wrapped 
around his waist. The Kaffir bo37^ after this operation is allowed 
to seize any married woman and have sexual intercourse with his 
captive. The foreskin of the Arunta bo}^ after this ceremony is 
swallowed b}^ his younger brother to ' ' strengthen him and make 
him grow tall and strong. " " The blood is rubbed over his elder 
sisters and they cut locks of his hair. ' ' 

"When the Egyptian boy is circumcised, at the age of five or 
six, he parades the streets, dressed as a girl in female clothes and 
ornaments, borrowed from some lady. In front of him also a 
school friend walks, evidently taking his place as a 'proxy,' for 
he wears round his neck the boy's own writing tablet. A woman 
sprinkles salt behind the boy to counteract 'the evil e3^e.' That 
is doubtless the reason why he is dressed as a girl." 

Dr. Remondino gives the following interesting account: ' 'Among 
the Gallinas of Sierra Eeon the clitoris of the young maid is ex- 
cised at midnight, while the moon is full, after which they receive 
their name. ' ' A man intruding upon this ceremon}^ would be 



WASHINGTON MEDICAL ANNALS 63 

killed. In Egypt and Arabia a society of Mussulmen circumcise 
young girls at the age of seven years, and this consists in excising 
the clitoris by means of scissors or pincers, as is the case at "Mos- 
soul." A grown woman who has been educated abroad, on the 
birth of her child is also operated upon. Excision of the clitoris 
at puberty occurs amongst the Amakosa, lyoanda, Masai and 
Wakusi tribes. In Australia girls are always excised at the age 
of puberty. 

The Monbuttu tribe west of Unyoro, many miles, circumcise men 
and women, and also cut out a " piece of the concha." Another 
authority states that in central Africa, the operation for ablation 
of the clitoris and labia minora is performed. We have read of the 
so-called Hottentot apron, which is said by some to be operated 
upon. In East Africa the labia majora, and part of the mons 
veneris are excised. The Gallas amputate the breasts of male 
children soon after birth, in order to keep them from becoming 
weak in body or effeminate. 

Trephining . — In the ancient burial grounds of the Palaeolithic 
or Archaeolithic age of Lubbock, and also the more recent stone 
age of Europe, called Neolithic, were found several fractured 
skulls, some of which had been trephined — thus proving the op- 
eration to have been quite common during the last period men- 
tioned — the polished stone age. In the cave of Cro Magnon, M. 
Ivouis I^artet, a celebrated paleontologist, found a female skull, 
the frontal bone of which showed a wound ' ' in the process of 
healing," caused by a flint weapon. A Danish dolichocephaloi^ 
skull of the stone age was found by the elder M. lyartet, which 
had been pierced by a spear. A fractured parietal bone, with 
flint axe sticking in it, was discovered in a cavern at Chauvaux, 
Belgium. 

Dr. Prunieres obtained from the interior of a dolmen, a skull 
which had been trephined in childhood, and the adult skull was 
found to have been trephined a second time. The piece of bone 
in this case, after death, measured seven inches long and five in 
the widest part. Many trephined skulls have been taken out of 
dolmens, and the pieces of bone which had been removed at the 
time of operation, were sometimes within the calvarium, or laid be- 
side the skull. No doubt, they made with a flint knife, a T-shaped 
incision before operating on the bone. Broca states that the bone 



64 WASHINGTON MEDICAL ANNALS 

was scraped through, and the disk removed. Occasionally two 
or three openings were made on the same subject. 

Dr. Prunieres has twenty skulls which had been trephined, and 
all recovered but one, amongst these pre-historic people. It is 
wonderful how successful the prehistoric surgeon was, consider- 
ing his often filthy surroundings, crude instruments, methods of 
operating, surgical treatment of wounds, and the usual careless 
way in which uncivilized men take care of their sick and wounded. 
So far as present discoveries seem to indicate, they seldom lost a 
patient. 

Out of these crania amulets were made ; the fragment of bone 
was circular, or of other shapes. These ornaments were talis- 
mans to protect the person from evil spirits in this world and the 
departed soul in the next. The posthumous amulets always had 
a piece of the ' ' cicatrized edge of the original opening' ' attached 
to the bone of which they were made. This fact proves beyond 
all dispute that the individual had lived a long period after the 
operation. 

The earliest history of remote ages is full of statements con- 
cerning certain nervous diseases called demons, evil spirits, etc. 
Such cases were either convulsions, delirium, epilepsy or mad- 
ness, due, no doubt, to various causes incident to the modes of 
life 'of individuals so afflicted. Sometimes these diseases were 
considered sacred, and at others viewed with superstitious awe, 
the family supposing that a devil possessed the sufferer's soul. 
The primitive surgeon treated these cases by trephining, in or- 
der to allow the demon to escape from the living person through 
the opening in the skull. Possibly they operated on the dead for 
the same reason. As epilepsy, and particularly convulsions, is 
common enough among children, this fact would seem to account 
for the frequency of the number of children's skulls that have 
.been trephined. / believe that this operation^ in niany cases ^ was 
performed by these primitive people to remove the bone pressing on the 
brain, and not always to let ont the devil. 

Savages have some intelligence, and even reasoning poivers, based 
on stirgical and medical experience. They may do many things 
that are foolish, but no more so than our ancestors, with their 
"Wound Salve," etc. Amongst the ancient inhabitants of the 
Canary Islands, "The Mound Builders of America," the oldest 
tribes of Mexico, of South America, and in the dolmens of Alge- 



WASHINGTON MEDICAL ANNALS 65 

ria, Africa, and, no doubt, Asia, to say nothing of the sunken 
continents, of Atlantis, off the African and Spanish coasts, and 
in- Lemuria, off the coast of Africa and Asia, where tradition 
says our race once dweh, the operation of trepanning, at some ad- 
vancing period of the race, toward a higher and more enHghtened 
civilization, was frequently resorted to in order to cure disease, 
and relieve brain pressure due to a fractured skull. Therefore, 
from evidence given, trephining is the oldest sicrgical operation of any 
magnitude that was performed by man. In fact, it can be said to have 
been tuiiversally adopted in all ages, past as well as present, as a re- 
cognized operation for the relief of diseases, and inf tries of the skidl 
and its contents. 

If you take any interest relative to the earlier history of tre- 
panning and age of the skulls mentioned, I refer you to the writ- 
ings of Broca, N. Joly, the lyartets. Dr. Prunieres, lyubbock, 
Fletcher, Figuier and others. The antiquity of this operation 
was hoary with age before the ancient traditions of the Egyptians 
had been born. It might be questioned, in speaking of the stone 
age of Europe, during which this surgery was performed, and in 
some cases said to have been trepanned after death, as an erroneous 
assertion. In some instances the specimen may represent inisticcessfil 
cases dying during or immediately after trephining . 

We have considered only one side of this operation of trepan- 
ning, that solely relating to antiquity, and it is well to investigate 
the surgery of the skull in our own era. Trephining is practiced 
in the Loyalty Islands, and Samuel Ella says it is a common be- 
lief there that headaches, neuralgia, vertigo and other head symp- 
toms are the result of a crack in the skull or pressure upon the 
brain, and to relieve this condition they make a T-shaped incision 
over the scalp down to the bone, and scrape the calvarium with a 
piece of glass until the dura mater is reached, the opening being 
the size of a silver dollar. ' ' Sometimes the operation in the hands 
of an inexperienced operator, or in consequence of impatient 
friends, is extended to the pia mater, and the patient dies in con- 
sequence. As it is, about fifty per cent, prove fatal. But owing to 
superstition this barbarous custom has become so prevalent that 
half of the adult population are seen with a hole in their skull." ■ 

Ella adds that he had been informed that sometimes thc}- 
reduce to a suitable size and thickness a piece of cocoanut shell, 
which they polish very highly, and place over the opening in the 



66 WASHINGTON MEDICAI. ANNALS 

skull to protect the brain of the patient. They formerly used a 
shark's tooth in operating. Usually they operated near the junc- 
tion of the sagittal and coronal sutures. ' ' George Turner con- 
firms these observations, and says whilst the mortality is great the 
curative effects are well marked." Their results compare favor- 
ably with those of the older surgeons prior to the antiseptic era. 

The Karaya Indians, of Brazil, use sharks' teeth for extract- 
ing splinters, etc. The Haussa of Northwest Africa use a primi- 
tive iron forceps in their surgery. The Colville Valley Indians, 
Spokanes and Kalispels poultice abscesses, whilst the medicine 
man of Lower California opens them by suction with his mouth. 
It may be well to pause and state that before the Civil War an 
old Virginia physician carried an old negro along with him to 
suck boils and taste the stools of his patients. 

The Frazier River Indians and the negroes of Victoria incised 
the part with iron or bone knives. The inhabitants of Tahiti, 
Samoa and Tonga open abscesses and boils with fragments of 
shell, flint, glass, large thorns and shark teeth. The Dyaks of 
Borneo use a wooden knife. Carbuncles are treated by the Kir- 
ghis, according to Pallas, by making "numerous punctures and 
by the application of tobacco and ammonia." Corre "saw the 
Fullahs of Rio Nunez treat an ulcer by comprevSsion with a sheet 
of native copper. ' ' 

" Castration appears to be a favorite treatment in hydrocele 
and orchitis, especially among the natives of Tahati, Samoa, 
Tonga and Loyalty Island." * 

Moore saw a native doctor at Radschputana apply a red-hot 
iron over an injured hernia. A savage of the Loyalty Island op- 
erated upon himself for a strangulated hernia, and died as a result 
of operation. While bathing in Brazil, in rivers, a small fish is 
liable to get into the urethra, and the natives remove this animal 
by external urethrotomy. 

Custoiiis Relating to the Prepuce. — Those who take interest in 
the religious customs relating to the use of the prepuce should 
read Remondino's work on circumcision, the chapter, " Miracles 
and the Holy Prepuce." The Indians pass a ring of gold, silver 
or iron through the foreskin, welding the ends together. In 
speaking of infibulation, Duuglison mentions that "the prepuce 
was first drawn over the glans, and that the ring transfixed the 

* Dr. George Kober's translation. 



WASHINGTON MEDICAL ANNALS 67 

prepuce in that position ; that the ancients so muzzled the gladi- 
ators to prevent them from being enervated by venereal in- 
dulgence." 

Infibulation was practised by the early Christian Monks of 
Greece and Asia Minor. When the Hindoo takes the vow of chas- 
tity, he wears a ring, attached to his penis ; the ring sometimes 
measures six inches in diameter. During the reign of Antiochus, 
Jews, who desired to be sexually, in appearance as those men 
around them, wore a copper instrument, of funnel shape, a tube 
in which they carried the virile member. Martial called it Jiidaem 
Ponduni. The idea was to lengthen the foreskin, so as to cover 
the glans penis. The results were failures. According to Remon- 
dino, St. Paul refers to this operation in his Epistle to the Corin- 
thians — 

" Was any one called being circumcised, let him not be uncircumcised." 

Emasculation, castration and eunuchism are of surgical inter- 
est. Mytholog}^ informs us that Uranos was successfully emascu- 
lated by his youngest son, Saturn, using, in this operation, a 
sickle made from a bright diamond. "As the members fell into 
the sea, and in the foam caused by the commotion from their con- 
tact with the element, Venus was born. Mean\vhile, the blood 
that dripped from the wounded surface caused the giants, the fu- 
ries, and the Melian nymphs to spring into life." Uranos was 
the first king of the now sunken continent of Atlantis, the first 
eunuch, and a god. 

The famous beauty, Queen Semiramis, is quoted as being the 
first to use eunuchs as servants and letting them hold high posi- 
tions of trust. Bergmann, of Strasburg, calls attention to the 
ancient tradition that the h^^ena instructed man in the operation 
of castration, because this animal, fearing rivals, castrated the 
young male hyenas. The Skoptsy , a Russian religious sect, castrate 
themselves. The Mahommedans, of India, use a sharpened razor 
and remove all the genitals. The bleeding is controlled by the 
application of herbs and hop poultices. Hemorrhage kills one- 
half of the victims. 

Dr. Morache, in the Dictionnaire Encyclopedic des Sciences 
Medicales,* describes the operation as follows: "The patient, be 
he adult or child, is, previous to the operation, well fed for some 

♦Chinese method of operating. 



68 WASHINGTON MKDICAL ANNALS 

time. He is put into a hot bath. Pressure is exercised on the 
penis and testes in order to dull sensibility. The two organs are 
compressed into one packet, the whole encircled with a silk band, 
regularl}^ applied from the extremity of the base, until the parts 
have the appearance of a long sausage. The operator now takes 
a sharp knife and with one cut removes the organs from the pubis. 
An assistant immediately applies to the wound a handful of styptic 
powder, composed of odoriferous raisins, alum and dried puff ball 
powder (boletus powder). 

' ' The assistant continues 'the compression till hemorrhage 
ceases, adding fresh supplies of the astringent powders ; a bandage 
is added, and the patient left to himself. Subsequent hemorrhage 
rarely occurs, but obliteration of the canal of the urethra is to be 
dreaded. If at the end of the third or fourth da}' the patient does 
not make water his life is despaired of. In children the operation 
succeeds in two out of three cases ; in adults, in one-half less." 

Eunuchs were made of prisoners of war by the ancient Egyp- 
tians, and by the Caribs when Columbus landed in America, and 
also previous to his time. At different periods the Romans, Span- 
iards, Britons and Poles castrated men for rape. In the earlier 
ages men who sang in choirs in the churches were castrated, in 
order to change their voices. The Coptic Monks have a eunuch 
factory. 

" The little, helpless and unfortunate prisoner or slave is stretched 
out on an operating table ; his neck is made fast in a collar fast- 
ened to the table, and his legs spread apart and the ankles made 
fast to iron rings ; his arms are each held b)^ an assistant. The 
operator then siezes the little penis and scrotum, and with one 
sweep of a sharp razor removes all the appendages. The result- 
ing wound necessarily bares the pubic bones and leaves a large, 
gaping sore that does not kindly heal. 

' ' A short bamboo cannula or catheter is then introduced into 
the urethra, from which it is allowed to project for about two 
inches, and no attention is paid to any arterial hemorrhage ; the 
whole wound is simply plastered up with some haemostatic com- 
pound, and the little victim is then buried in the warm sand up 
to his neck, being exposed to the hot, scorching rays of the sun. 

" The sand and soil is tightly packed about his little body so as 
to prevent an}'- possibility of any movement on the part of the 
child, perfect immobility being considered by the monks as the 



WASHINGTON MEDICAL ANNALS 69 

main element required to promote a successful result. // is esti- 
mated that J J, 000 little Africans are annually sacrificed to produce 
the Soudanese ave) age ^quota of its j, 800 eumichs." 

These eunuchs sell from $750 to $1,000 a head. Hammond 
speaks of eunuchs among the Indians of New Mexico and Ari- 
zona. The Scythians often became eunuchs as a result of riding 
bareback. Some of the ancient heathen priests soaked the scro- 
tum in hot water, and by gentle and firm friction, in the course 
of time made the testicles disappear. The ancients used several 
methods of operating. Remondino says : ' ' From the removal of 
all the genitals, or the penis alone, or the scrotum and testicle, 
or removing only the testicles, down to compression or to distort- 
ing the spermatic vessels." The possibility of a bad fitting bic}'- 
cle saddle, under certain conditions, and if not properly adjusted, 
and constantly used for a long time, day after day, may affect the 
sexuality of the male, in the same way horseback riding affected 
the ancient Scythian. 

According to Paulus Aegineta, in making eunuchs of boj-s, the 
mortality w^as very small. Among the Turks, according to 
Chardin, three out of every four operated upon died. Clot Bey 
states that two out of three died. Bisson saj^s the mortality was 
nine out of ten. St. Alphonsus M. lyiquori said that men were 
not saints, and a man was a fool who allowed his daughter to 
take music lessons from any man other than a eunuch. 

Pope Clement XVI abolished the practice of emasculating boys 
for church choirs, etc. Napoleon the First did likewise secularly 
and socially. This custom of emasculating men was practised in 
China during the reign of the emperor Yeu "Wang, 781 B. C. 
Very often eunuchs are made mutes by operating on the tongue, 
and are much preferred. 

The Effects of Syphilis on the Negro Race. — Dr. J. Wellington 
Byers, in an article entitled " The Influence of Race and Nation- 
ality upon Disease," states : " Darwin and Borius assert that the 
negroes of Madagascar are exempt, while the Hovas, of the Malay 
race, are frequently and seriously affected. There seems to be 
some ground for the popular notion that syphilis contracted from 
Mongolian blood by Europeans is particularly noxious, as all ex- 
amples of such prove very intractable." Then he quotes from 
Dr. Livingstone : 

"A certain loathsome disease which decimates the North Amer- 



JO WASHINGTON MEDICAL ANNALS 

ican Indian and threatens extirpation of the South Sea Islanders 
dies out in the interior of Africa without the aid of medicine ; and 
the Bangwasf who brought it from the Wejl^. coast, lost it when 
they came into their owm country, southwest of Kolobeng. It 
seems incapable of permanence in any form in persons of pure 
African blood an3^where in the interior of the country. In per- 
sons of mixed blood it is otherwise, and the virulence of the sec- 
ondary symptoms seemed to be, in all cases that came to my care, 
in exact proportion to the greater or lesser amount of European 
blood in the patient. Among the Corannas and Griquas of mixed 
blood it produces the same ravages as in Europeans. In half- 
blood Portuguese it is equally frightful in its inroads upon the 
system, but in the pure negro of the central part it is quite inca- 
pable of permanence. " 

Fritsch, in commenting upon this opinion of Livingstone, sa3's, 
that "syphilis is very rare in Bechuana Land ; only in scattered 
cases, mostly imported from Cape Colon}' , though there are ma- 
terials with which to controvert the assertion that this disease 
does not hold good wath pure Ethiopian blood. 

' ' That this disease does attack the negro in a mitigated and less 
virulent form than it does the white and other races appears pro- 
bable from past experiences in this country. The last census 
shows the disparity ; and from my own personal observation the 
disease is far less formidable in the negro, and is readily cured by 
appropriate treatment. It certainly, upon the whole, pursues a 
milder course, there is less dam^age to the system, and there are 
fewer lesions of any kind." 

Savages have various methods of treating syphilis; roots, 
herbs, minerals, mineral waters, baths and massage they also em- 
ploy to relieve pains. 

Rtibbioig with the hands is used both in savage medicine and sur- 
gery, as no doubt this method is of the greatest antiquity. Dr. -Z — -r-. 
cT-< — > •■■■■~statesthat Adam, having eaten the forbidden fruit given 
him by Eve, was that night seized with a violent colic. Eve, in 
her blushing innocence, used massage over Adam's abdomen. 
Possibly, I may add, this ma}^ throw some light on the dark side 
of history relating to the subsequent events — the birth of Cain 
and Abel. Adam was an anatomical curiosity, it is stated, in not 
having a navel, Jor he had no use for one, not being born of a 
woman. . 



WASHINGTON MEDICAIv ANNALS 71 

In the writings of a Chinese writer, Kong Fu, 700 B. C, "a 
full description of medical gymnastics and massage as practiced 
at that time" is described. " The Hindu Vedas, or Books of Wis- 
dom," contain paragraphs showing "gymnastics and massage 
were well known" in ancient times in India. The Phoenicians, 
Persians, Egyptians of old, and ancient Greeks used massage. 
Hippocrates advocated the use of massage, and " other physicians 
of ancient Hellas." The ancient Romans borrowed it from the 
Greeks, and it was used by the Latins in conjunction with their 
baths. 

Fevers belong not only to the field of medicine, but also to the 
domain of surgery. Rome had a goddess of Fever. The old-time 
surgeons and physicia?is used powerful drugs and bleeding in tJie 
treatment oj Jever and other diseases. So did the savage of the past, 
as well as of the present. 

Transfision of Blood. — The following quotation may be of in- 
terest, aiid, on the part of the assertion of the author quoted, 
rather startling, from a medical point of view. It is copied from 
a medical journal quoting from a paper in another medical peri- 
odical : " Transfusion, which is transmission of the blood of one 
animal into the circulation of another, was practiced centuries be- 
fore the birth of Christ, yet why this should have been done when 
the circulation of the blood was not understood is hard to ex- 
plain." It might be asked if this fact was not an interpolatio7i 
occurring in an old medical ivork, haviiig been inserted there dziring 
ojir era. Some authorities claim interpolations of recent origin 
have been found in ancient Hindu medical books. 

Pages upon pages can be written on the subject of savage sur- 
gery. We only, as a rule, compare the extremes, but the divid- 
ing line is not so well marked. Man at his best is a veneered 
savage. Many of the men of our times are but little removed 
from the wild men of the verdant forests, the hot-blooded son of 
the golden sands of the desert, the .stalwart dweller of the clift 
and mountain, the cultivator of the fertile plains and the lords of 
the gems of the emerald isles, surrounded by the deep blue sea, 
whose music on the shell-girdled shores lulls them each night into 
a sweet repose. The so-called semi-civilized man of Northern 
Africa uses trusses in the treatment of hernia, yet he is a savage. 
The subject I have presented for your consideration is of the 
greatest interest to me, and I hope of like interest to you. The 



72 WASHINGTON MEDICAL ANNALS 

histor}^ of medicine is of the greatest importance, and so is that 
of surgery. The poet says : 

" Know then thyself, presume not God to scan. 
The proper study of mankind is man." 



1 



LIBHARY OF CONGRESS 



029 726 918 5 



